Intravenous corticosteroids in moderately active ulcerative colitis refractory to oral corticosteroids

Abstract

Intravenous corticosteroids are efficient for inducing remission in moderately active UC unresponsive to oral corticosteroids, but almost half of these patients develop early steroid-dependency. Alternative therapeutic strategies should be assessed in this clinical setting.

Steroid-refractory ulcerative colitis: a critical review of national and international guideline recommendations

“…In hospitalized adult patients with acute severe ulcerative colitis refractory to intravenous corticosteroids, the AGA suggests using infliximab or cyclosporine. (low quality evidence) This recommendation is perfectly in line with the literature concerning i. v.-steroids [41] and that quoted above, but reasons for the use of steroids only in inpatients is not clarified in the text. Other anti-TNFs, vedolizumab, ustekinumab, or tofacitinib are not considered, probably because of only indirect evidence in less severe acute colitis.…”

Aktualisierte S3-Leitlinie Colitis ulcerosa

“…Dazu gehören engmaschige Laborwertkontrollen, mikrobiologische Untersuchungen (Reiseanamnese erheben), physio-und ggf. psychotherapeutische Betreuung und Bluttransfusionen [322] [349,350] Verschiedene für die CU wirksame TNF-Antikörper können daher auch in der steroidrefraktären Situation eingesetzt werden. Bei der Wahl der TNF-Antikörper bei steroidrefraktären Verlaufsformen ist in der klinischen Situation letztlich die Aktivität der Erkrankung von entscheidender Bedeutung.…”

Updated S3-Guideline Ulcerative Colitis. German Society for Digestive and Metabolic Diseases (DGVS)

“…4. exclusion of Clostridium (C.) difficile infection, which occurs frequently in patients with severe ulcerative colitis and has been associated with increased mortality and morbidity [ Chapter 4). Intravenous steroid therapy has been shown to be more effective in confirmed ulcerative colitis refractory to oral steroids, e. g., in a retrospective study of 110 patients [348,349]. However, almost half of the patients in this study went on to develop steroid-dependent disease.…”